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Bulgarian Review of Ophthalmology

Tonic Pupil

S. Cherninkova


Twenty cases with isolated (local) tonic pupil due to involvement of the postganglionic parasympathetic fibers are reported. The typical syndrome of a tonic pupil with the following clinical signs is described: (1) a mydriatic pupil with a poor or absent reaction to light, (2) a normal, strong and tonic reaction to near stimuli with tonic and delayed redilation after constriction, (3) accommodation paresis, and (4) denervation supersensitivity to cholinergic drugs. Тhe presumable cause of tonic pupil syndrome in 7 of our patients is a viral infection (grippe, varicella, respiratory infections), in 2 – blunt orbital trauma, in 1 – local anesthesia, in 1 – laser cerclage, in 1 – Hodgkin’s disease, as the appearance of a tonic pupil is during remission, in 1 – probable ischemia of the ciliary ganglion оr short ciliary nerves. In 7 patients etiology is unclear, i.e., idiopathic tonic pupil is present. In 10 patients a dynamic follow-up was performed.


postganglionic parasympathetic lesion, tonic pupil

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About The Author

S. Cherninkova
University Hospital Aleksandrovska ‒ Sofia

Clinic of Neurological Diseases